Coburn Kids

Thought I would do a blog on clefts, and explain more about them. Clefts are the 2nd most common birth defect in the world, right behind a club foot. About 1 in 750 babies will be born with them, in Utah that rate is 1 in 450 or .2% of babies. The rate of having a bilateral cleft lip and palate is even rarer at .06% of babies. They are considered a multi-factor defect, meaning that there’s not just one cause for them, or they can’t pinpoint it to just one cause. They can be genetic, environmental, caused by certain drugs during pregnancy, and smoking. While they recommend those who have had previous cleft children to take a large amount of folic acid, this isn’t a guarantee since they can’t pinpoint exactly what causes them. Caden was certainly a planned pregnancy and I was on prenatal’s. So we don’t know why exactly Caden has a cleft since we have no family history of them. It’s why it can be so hard to accept, that there was nothing you did wrong or could have done to prevent it. It can happen to anyone though.

While the cleft anomaly can “run in families” or show up in conjunction with a syndrom (e.g. Pierre Robin Sequence, Treacher Collins, etc.), most often a cleft shows itself as an isolated incident. This is known as a nonsyndromic cleft which is what Caden has.

A good explanation for what happens in the womb I’m going to take from another blog called Cleft Notes, complete with pictures so you can get a better idea of what this all looks like and what happens.

When someone is born with a cleft LIP, they have an opening in the upper lip. Normally the lip is formed by the union of two tabs of tissue that grow in from the sides of the face with a central tab that grows down from the tip of the nose. This union takes place around 4-6 weeks of embryonic development. Here is an excellent picture of these fusion points:
The formation of our face is actually quite complex. If you hold your 2 hands together in a cupping shape and and proceeded to fold your fingers inward, there are a number of tabs that fold inward and latch. These folds give rise to our nose and our mouth. Here is another picture depicting a 5 week fetuses (this is what we all looked like at 5 weeks old!) that shows the places where our lips latch very clearly:
Another way to get a good idea of what I am talking about, is to take a look at your face in the mirror. See those 2 small lines coming down from your nostrils to the tips of your cupid’s bow of your lips? Those lines are called the philtrum and are “scars” from the folds where your face came together during embryonic development. This fusion should take place in the fourth to sixth week of pregnancy. If the union is not complete, the baby is born with a cleft lip.

Now, there are different kinds of clefts that can occur with the lip.

If the cleft extends up into the nostril it is called a ‘complete cleft lip’. If the nose is not affected it is called an ‘incomplete cleft lip’. When both sides of the lip don’t latch, then it is a bilateral cleft lip.Caden of course was born with a bilateral incomplete cleft lip, since it did not extend up into the nose area and there was a thin stretch of skin underneath there.

When a cleft of the palate occurs, it can affect the hard and soft palate. Here’s a little way to explain where your hard and soft palate are. Open your mouth wide and look into a mirror. Place your tongue at the top of your mouth, near the front by your teeth. You will notice this is hard and is likewise your HARD palate. If you look at your hard palate in the mirror, you may even be able to see the whitish line down the center, where your palate “zippered shut” in the embryonic stage of development.

Now look further back in your mouth. Move your tongue from the hard roof of your mouth back towards where it becomes soft and elastic. This is where your soft palate begins. If you look far enough back, you will see your little uvula (the little ball which hangs down) and that is the end tip of the soft palate.

Like the lip, there are varying forms of a cleft of the palate. Some babies are born with just the soft palate affected by a cleft. Other babies are born with the entire roof of the mouth (both hard and soft palates) affected. For Caden, he had a cleft of the hard and soft palate. There are also very minor forms of clefts of the soft palates which include a submucosal cleft and a clefted uvula. I couldn’t find a picture of a submucosal cleft, but I did find one of a clefted uvula: